In Corzine’s Recovery, Doctors Cite Grit and Luck

Gov. Jon S. Corzine of New Jersey at a press briefing on Monday at Drumthwacket, his official residence. Behind him were one of his physicians,
Dr. Steven E. Ross, left; Attorney General Stuart Rabner; Sharon Elghanayan, Mr. Corzines companion; and his son Jeffrey.Credit
Mel Evans/Associated Press

CAMDEN, N.J. — Dr. Steven E. Ross was about to perform an appendectomy shortly before 7 p.m. on a routine Thursday when a nurse paged him to say the governor of New Jersey had suffered an open femur fracture and severe chest injuries and was about to land on the helipad atop Cooper University Hospital here.

“Quite honestly, I didn’t believe it,” said Dr. Ross, who directs the level one, or most highly accredited, trauma center at the hospital. But he immediately alerted security guards and the public relations staff so they would “keep people out of my hair” and help him avoid “the distractions” that can interfere with the care of V.I.P.’s.

Dr. Robert F. Ostrum was watching the Phillies-Mets game on television at his home just across the Delaware River in Philadelphia that Thursday, April 12, when an announcer interrupted to say that Gov. Jon S. Corzine was being flown to Cooper.

In his 25-year career, Dr. Ostrum, the chief trauma orthopedist at the hospital, had repaired about 800 femur fractures, including 200 open ones. He called his colleagues and said he would come in, in part because of the patient’s prominence.

So began the medical odyssey to which Mr. Corzine, 60, owes his life. He was not wearing a seat belt while riding in a state vehicle clocked at 91 miles per hour and nearly became one of the more than 43,000 people a year who die in car crashes in the United States.

Instead, after 11 days in intensive care, eight of them on a ventilator, and three operations on his leg, Mr. Corzine was released from the hospital on April 30 and resumed his official duties as governor six days later.

In their first extensive interviews, doctors and nurses who treated Mr. Corzine here attributed his amazingly fast recovery to his speedy arrival at a trauma center, his grit in overcoming severe pain to begin rehabilitation, and luck.

Mr. Corzine still needs strong painkillers that can impair judgment, but he has not allowed the doctors to disclose the drugs’ names or share his X-rays or medical chart. He has also refused The New York Times’s repeated requests for interviews.

But in lengthy conversations with this reporter, who is a physician, the medical team that saved his life revealed many new details about Mr. Corzine’s injuries, his treatment and the first three and a half weeks of his recovery.

Over the first 24 hours in the hospital, Mr. Corzine received 12 pints of blood, an amount roughly equivalent to the total blood volume in his body. Most of the bleeding was internal, into muscles and the chest from 15 broken bones.

But because the blood was replaced as he lost it, he avoided shock, a key way in which immediate trauma care saves lives.

The jagged femur had torn through his thigh muscles and skin to create an open wound six and a half inches long — “By our standards it was pretty large,” Dr. Ostrum said — and to repair it, doctors had to insert a titanium rod through the center of the broken bones and screw them in place.

When Dr. Ostrum found that the longest rod was too short for Mr. Corzine’s femur, he added an extension. “I didn’t shorten him,” he recalled, smiling.

The day after the accident, Mr. Corzine’s family brought specialists in trauma and orthopedics from New York University to review his case.

In the coming days, with Mr. Corzine unable to speak because of the tube connecting his windpipe to the ventilator, David Donaghy, a nurse, read his lips as one way to respond to his wishes for more pain medication or ice water.

And when Mr. Corzine could talk again after a week of semiconsciousness, the chief topics of conversation were baseball and the New Jersey Devils hockey team, the doctors said.

‘Do What You Have to Do’

About 500 of Cooper’s 2,500 trauma cases each year arrive via the helipad, with its view of the Philadelphia skyline. As they waited for Governor Corzine to land on April 12, Dr. Ross, a trauma nurse, a nurse anesthetist, a respiratory therapist and an emergency medical technician received word that he was conscious but on oxygen because of difficulty breathing due to his chest injuries.

An anesthesiologist injected sodium pentothal, a rapidly acting barbiturate, to put Mr. Corzine to sleep, and succinylcholine, a muscle relaxant, to allow doctors to quickly insert a tube in his windpipe and connect it to a mechanical respirator.

Hospital aides wheeled Mr. Corzine to the basement for CAT scans looking for evidence of brain damage; tears in the aorta, the body’s main artery; or damage to the heart, lungs, spleen, liver and intestines.

Mr. Corzine escaped those problems. But he had a number of fractures: the femur, sternum, a collarbone, a vertebra and 11 ribs. The broken ribs were in the central area of the chest, six on the left side and five on the right. Two of the ribs on the left were broken in two places.

An enormous force is needed to break the thick sternum and that many ribs in a chest cage that is designed to protect the heart and lungs. Dr. Ross, who has treated about 100 patients with injuries like Mr. Corzine’s, said the governor was “just lucky” to have escaped heart and lung damage.

At 8:30 p.m., Dr. Ostrum began repairing the femur. Aligning the pieces was difficult because the bone was broken in two places, leaving one piece floating and unattached.

“Normally, you take the hip on one end and the knee on the other and put them back together again like pieces of a jigsaw puzzle,” Dr. Ostrum explained. “When you get more pieces it gets more difficult.”

In the three-hour operation, Dr. Ostrum removed as much dead muscle and other tissue as possible to help prevent infection. The thigh wound needed to be cleaned in two additional surgical procedures, on April 14 and 16.

Photo

Dr. Ross and Tom Shea, Mr. Corzines chief of staff, at a press briefing on April 23 at Cooper University Hospital.Credit
Tom Mihalek for The New York Times

About midnight that first Thursday, Dr. Ostrum and Dr. Ross met with two of Mr. Corzine’s three children, advising them that he was in critical condition.

“All of us thought he would survive,” Dr. Ostrum said. He did not “paint a bleak picture,” he said, adding, “but I wanted them to understand the severity of the injuries.”

There were potential fatal complications: pneumonia; other infections; acute respiratory distress syndrome; blood clots in the leg that could travel to the lungs or other organs and cause emergencies, if not sudden death.

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“It’s counterproductive to tell somebody everything’s going to be fine, and then when you do have problems, hear, ‘Doctor, you told us everything was going to be fine,’ ” Dr. Ross said. “I would rather tell them about the realities and have everybody happy when things go well.”

Mr. Corzine’s children were “not in any mental state to ask specific medical questions at that point,” he said, adding: “They were pretty distraught. They wanted to see him as soon as they could.”

After talking with the family, the doctors reluctantly participated in a news conference at the request of Mr. Corzine’s aides. They said they were hesitant in part because of the federal Health Insurance Portability and Accountability Act, which prohibits the release of a patient’s medical information without explicit permission. At the time, Mr. Corzine was under heavy sedation.

One More Fracture

The first week was the diciest, with Mr. Corzine, who was in an isolation room for security reasons, using a mechanical ventilator because in one small area the broken ribs were unable to help the lungs expand, creating what is known as a flail chest.

The doctors still did not know whether Mr. Corzine was paralyzed. So they reduced the amount of sedation to observe his spontaneous movements and to ask him to follow their commands. When he moved both arms and both legs, the doctors became more optimistic.

Later, they performed a fuller examination.

“We just pat them down all over to make sure we did not miss any fractures or dislocation,” Dr. Ostrum said. After the swelling subsided, they found that Mr. Corzine had also dislocated the last joint in his right middle finger.

Trauma doctors measure recovery in part by what patients want to talk about and do; when patients talk about subjects other than their injuries, they take it as a sign of progress. Mr. Corzine’s doctors said they were encouraged that baseball and the Devils’ playoff run were among his favorite topics.

At Cooper, doctors typically take turns caring for trauma patients every day. But Dr. Ross said that as the director, he wanted “to keep an eye on things,” so he accompanied the duty doctor on daily rounds, a move that could mean stepping on a colleague’s toes.

“When one attending surgeon looks over another attending physician’s shoulder, they get irritable,” Dr. Ross said, adding with a smile, “because we all know everything.”

Executive Decisions

Once he was off the ventilator, Mr. Corzine read several newspapers each day, the doctors said, but he did not do office work in the hospital.

In considering when Mr. Corzine could resume his official duties, the two main doctors — along with Dr. Michael E. Goldberg, the anesthesiologist who controlled his pain medication — discussed the timing and criteria among themselves and with members of the governor’s staff, state lawyers and the governor’s personal physician, who declined to be identified.

They considered what criteria might apply to the return to work of lawyers and business executives, or of physicians like themselves who care for critically ill patients.

Paramount was the worry that Mr. Corzine’s pain medication could impair his thinking.

So they interviewed him, informally testing his memory. They discussed sports and current affairs. He said he was less familiar with South Jersey than the central and northern areas. The doctors were satisfied that he was absorbing the information and asking appropriate questions.

“We gave him specific advice on how much we want him to limit his formal schedule,” Dr. Ross said. “We pushed the window back until he and we felt that he could respond if somebody needed him at 3 o’clock in the morning for an emergency.”

The doctors said Mr. Corzine seemed lucid, coherent and sharp. “You can’t tell he is on any medication at all,” Dr. Ostrum said.

After visiting Mr. Corzine at Drumthwacket, the governor’s mansion in Princeton, on May 4, Dr. Ross decided that as a New Jersey resident he was “comfortable with him making executive decisions on my behalf.”

Yet Mr. Corzine erred describing a broken bone in an interview conducted last Sunday and broadcast the next morning, the day he resumed his official duties. Speaking on NBC’s “Today” show, Mr. Corzine said he had broken his tibia, the shin bone, not his femur.

‘Every Time They Cough’

The main rehabilitation goal is for Mr. Corzine to restore his leg motion, then improve its strength and endurance. He uses arm crutches, instead of standard ones, to avoid aggravating his ribs.

He has three daily physical therapy sessions and is scheduled for monthly checkups through the summer. The doctors plan to monitor X-rays periodically to determine how well his femur is healing and when he can put weight on his leg.

Mr. Corzine still is not out of the woods, Dr. Ostrum said. A possible complication is osteomyelitis, a serious bone infection. Also, rib fractures are generally painful for weeks.

“You can fix every bone in their pelvis and both their legs, and they will come back and complain about ribs every time they take a deep breath, every time they cough, every time they roll over in bed,” Dr. Ostrum said.

Mr. Corzine, who has pledged to educate others about wearing seat belts, has said he remembered getting into the helicopter but virtually nothing about the first eight days in intensive care.

That was good news to Dr. Ross. The drugs that Mr. Corzine received in intensive care are the same that patients may receive when undergoing procedures like a colonoscopy, to ease their discomfort.

“One effect of the drugs is amnesia,” Dr. Ross said. “We think it’s a good thing that patients don’t remember what they go through in the I.C.U.”

Correction: May 17, 2007

An article on Sunday about the extensive medical care that Gov. Jon S. Corzine of New Jersey received at Cooper University Hospital in Camden after a traffic accident on April 12 misstated the date of Mr. Corzine’s release in some copies. It was April 30, not May 1.

A version of this article appears in print on , on Page A29 of the New York edition with the headline: In Corzine’s Fast Recovery, Doctors Cite Timing, Grit and Luck. Order Reprints|Today's Paper|Subscribe